TY  - BOOK
AU  - Iantorno, Micaela
AU  - Shlofmitz, Evan
AU  - Waksman, Ron
TI  - Restenosis of Drug-Eluting Stents: A New Classification System Based on Disease Mechanism to Guide Treatment and State-of-the-Art Review. [Review]
SN  - 1941-7640
PY  - 2019///
KW  - *Coronary Artery Disease/th [Therapy]
KW  - *Coronary Restenosis/th [Therapy]
KW  - *Drug-Eluting Stents
KW  - *Percutaneous Coronary Intervention/ae [Adverse Effects]
KW  - *Percutaneous Coronary Intervention/is [Instrumentation]
KW  - Clinical Decision-Making
KW  - Coronary Artery Disease/dg [Diagnostic Imaging]
KW  - Coronary Restenosis/dg [Diagnostic Imaging]
KW  - Coronary Restenosis/ep [Epidemiology]
KW  - Decision Support Techniques
KW  - Humans
KW  - Incidence
KW  - Patient Selection
KW  - Prosthesis Design
KW  - Retreatment
KW  - Risk Factors
KW  - Treatment Outcome
KW  - MedStar Heart & Vascular Institute
KW  - Journal Article
N1  - Available online from MWHC library: 2008 - present
N2  - Despite on-going evolution and iteration of drug-eluting stent (DES) technology, the prevalence of in-stent restenosis (ISR) remains relatively unchanged, encompassing =10% of percutaneous coronary interventions. The mechanism of ISR is multifactorial, including biological, mechanical, patient, and operator-related factors. The main mechanical contributors are stent underexpansion or fracture, while biological factors include local inflammation leading to aggressive neointimal proliferation and late neoatherosclerosis. Intracoronary imaging is critical to identify the mechanism of ISR and tailor therapy accordingly. The presentation of DES-ISR is not benign and is challenging for optimal treatment. Among the proposed treatment modalities are scoring and high-pressure balloons, percutaneous coronary intervention with additional DES, atheroablative therapies by laser or mechanical atherectomy, drug-coated balloons, vascular brachytherapy, and surgical revascularization. We propose a new classification for ISR that differentiates among mechanical, biological, and mixed etiologies. Stratifying ISR by mechanism guides individualized treatment of DES-ISR to improve clinical outcomes. An algorithmic approach, guided by intracoronary imaging, for the treatment of DES-ISR, is recommended based on the specific cause of restenosis
UR  - https://dx.doi.org/10.1161/CIRCINTERVENTIONS.118.007023
ER  -